Management of proximal tibial fractures by posteromedial locking compression plate

Abstract

Management of tibial plateau fractures aims to restore normal knee functionality by near normal anatomical restoration of the articulating surfaces, thereby maintaining the mechanical axis and restoring ligamentous stability. Plate fixation is important when a medial plateau is involved in proximal tibial fractures. The present study was designed to assess the management of medial condylar fractures of proximal tibia treated by posteromedial locking compression plate. A total of 30 cases with Schatzker type IV-VI fractures to the proximal tibia, who followed up for clinic radiological evaluation, between age group 20-60 years were recruited. Clinical examination and radiological investigations were performed to review the fractures. The fractures to the medial condyle of tibia were treated by posteromedial approach. Post-operative care has been initiated with physical therapy in the form of quadriceps exercises. The postoperative follow up was continued at the end of one month, three months and six months and outcomes were recorded by using Lysholm knee score. According to Schatzker type of fractures 46.6% had type IV, 33.3% had type V and 20% had type VI fractures. Majority cases had fractures due to road traffic accidents (70%). Postoperative fracture outcome showed excellent outcome in 78% cases, good results in 16%, fair results in 6% and none of the case had a poor outcome. In postoperative complications, 80% cases were recovered without complications, 10% cases had superficial infection, 7% cases had knee pain, and 3% cases had knee stiffness. The posteromedial approach of tibial fracture management is safe with minimal complications. Fixation of posteromedial tibia permits quick reformation of the patient with outstanding functional outcome with minimal incidence of complication.